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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495186
Report Date: 11/29/2022
Date Signed: 11/29/2022 11:37:50 AM

Document Has Been Signed on 11/29/2022 11:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CII/YMCA EARLY HEAD STARTFACILITY NUMBER:
197495186
ADMINISTRATOR:JUSTINE LAWRENCEFACILITY TYPE:
830
ADDRESS:9900 S VERMONT AVENUETELEPHONE:
(323) 905-1042
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 6TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Erika Avila, Site SupervisorTIME COMPLETED:
10:35 AM
NARRATIVE
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On 11/29/2022, Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced case management visit at CII/YMCA Early Head Start for the purpose of following up on Action Lead Exceedance (ALE) in water used for drinking and food preparation in the building. LPA met with Erika Avila, Site Supervisor and toured the facility. During today’s visit there are 3 Infants and 2 Teachers.

Per Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

Community Care Licensing was notified of the results of the Lead Water Testing conducted at the facility on September 23, 2022 and a follow up test conducted at the facility on November 8th 2022. The sample tests for water/faucet outlet located in Prep Kitchen (A) exceeds allowable limit for lead. The exceedance of 5.5 ppb/ug was identified at the facility above the kitchen water faucet. This poses a potential health and safety risk to children in care.

LPA received an email from the facility with copies of External Water Sampler Self-Certification Form (LIC 9275); Child Care Center Sampling Checklist Form (LIC 9276); Facility Sketch (LIC 999) in which all water outlets are noted; and A copy of water testing results summary.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CII/YMCA EARLY HEAD START
FACILITY NUMBER: 197495186
VISIT DATE: 11/29/2022
NARRATIVE
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During today’s visit LPA observed water faucet A identified on facility sketch with elevated lead levels are, labeled with out of service signs and facility has ceased usage. Kitchen faucet is not used for children consumption or food preparation per staff. LPA received pictures of faucet/outlet A.

The director has posted testing results, in a location consistent with the requirements of subsection (b) of section 1596.8595 of the Health & Safety Code, for parents and families to view at the facility during operating hours. Based on observation, interviews and sampling records it has been determined that there was a violation. During today’s visit a Type B violation under 101700.3(b)(1) California Lead Action Level at Child Care Centers has been cited, see (LIC 809D).

LPA discussed the following Plan of Correction with the Site Supervisor. The facility has replaced faucet/outlet A and will hire a independent contractor to test the pipes. This unit was replaced by a certified plumber. The water faucet/outlet labeled A will remain shut off with signs posted pending retesting.

The facility has provided all documentation and immediate actions have been taken to bring down lead levels. The facility has provided notification to parents/guardians of children in care with information about what has been done and remediation plans for kitchen faucet.

A copy of this facility evaluation report (LIC 809 & LIC 809D), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to the Site Supervisor.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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Document Has Been Signed on 11/29/2022 11:37 AM - It Cannot Be Edited


Created By: Shandra Powell On 11/29/2022 at 10:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CII/YMCA EARLY HEAD START
FACILITY NUMBER: 197495186

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2022
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers(b) Testing results with fractional ppb readings of 0.5 ppb or greater....(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. The requirement was not met as evidence by:
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LPA discussed Proof of Correction (POC) with Site Supervisor. Facility has cease the use of kitchen faucet, changed the faucent unit and posted and sent out notification letters to parents.
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Lead water testing samples taken on 09/28/2022 revealed that levels of lead were beyond the allowable amount deemed by the State of California. Water Outlet “A” has Action Lead Exceedance (ALE) level 5.51 pbb.
This poses a potential health and safety risk to children in care.
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The facility will continue to correct the exceedance. Facility has hire plummer and has been given guidance to test pipes which will be contracted by a company and retesting will continue. Facility will send a copy of all reports to LPA via email.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karren Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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